The fetal spleen is involved in the response to intrauterine infection and inflammation. The flow pattern of its vein is not pulsatile in normal conditions. The aim of the study was to determine whether the presence of histological chorioamnionitis and funisitis is associated with a continuous or pulsatile flow pattern in the fetal splenic vein. We performed a prospective study including 79 women with preterm prelabor rupture of membranes. We found a relation between pulsation in the splenic vein and histological chorioamnionitis (likelihood ratio 13.2), as well as funisitis (likelihood ratio 5.7). Ultrasound evaluation of the splenic vein could be a non-invasive tool for the prediction of these inflammatory complications.

• MeSH
• Chorioamnionitis physiopathology   ultrasonography   MeSH
• Adult MeSH
• Humans MeSH
• Fetal Membranes, Premature Rupture physiopathology   MeSH
• Predictive Value of Tests MeSH
• Pulsatile Flow MeSH
• Pregnancy MeSH
• Ultrasonography, Doppler, Color MeSH
• Ultrasonography, Prenatal MeSH
• Splenic Vein physiopathology   ultrasonography   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE: To determine whether the measurement of the transverse diameter of the fetal thymus is of value in the identification of either histologic chorioamnionitis or funisitis in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). METHODS: The transverse diameter of the fetal thymus was measured in 216 fetuses from PPROM pregnancies. A small thymus was defined as a transverse thymic diameter below the fifth percentile according to a previously published nomogram. The placenta, the fetal membranes, and the umbilical cord were assessed for the presence of inflammation. RESULTS: A small thymus was identified in 69% (150/216) of fetuses. A small thymus was present in 80% (106/133) and 88% (36/41) of women with histologic chorioamnionitis or funisitis, respectively. The presence of a small thymus had a sensitivity of 79%, specificity of 47%, positive predictive value of 71%, negative predictive value of 59% for the identification of chorioamnionitis (p < 0.0001; odds ratio 3.5) and a sensitivity of 88%, specificity of 35%, positive predictive value of 24%, and negative predictive value of 92% in the identification of funisitis (p = 0.004; odds ratio 4.4). CONCLUSIONS: The sonographic finding of a small thymus is a sensitive indicator of histologic chorioamnionitis or funisitis; low specificity excludes it as a possible clinical implication in the management of PPROM pregnancies.

• MeSH
• Chorioamnionitis etiology   ultrasonography   MeSH
• Adult MeSH
• Gestational Age MeSH
• Humans MeSH
• Fetal Membranes, Premature Rupture * MeSH
• Predictive Value of Tests MeSH
• Sensitivity and Specificity MeSH
• Pregnancy MeSH
• Thymus Gland embryology   ultrasonography   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: To evaluate umbilical cord interleukin (IL)-6 and funisitis as independent predictors of early-onset neonatal sepsis (EONS) in preterm prelabor rupture of membranes (PPROM). DESIGN: Prospective cohort study. SETTING: Evaluation of umbilical cord IL-6 and funisitis as predictors of early-onset neonatal sepsis in PPROM. POPULATION: 176 women with PPROM between 23+0-36+6 weeks of gestation. METHODS: Umbilical cord IL-6 was assayed by ELISA. Funisitis was defined according to the Salafia classification. Data was adjusted by gestational age at delivery and prenatal administration of corticosteroids and antibiotics. MAIN OUTCOME MEASURES: Binary logistic regression was performed to assess the independence of umbilical cord IL-6 and funisitis to predict EONS in women complicated with PPROM. RESULTS: The rate of EONS was 7%. Funisitis was present in 18% of women. Umbilical cord IL-6 was significantly higher in women complicated with EONS than without [median (range) 389.5 pg/mL (13.9-734.8) vs 5.2 (0.1-801-4), p<0.001]. Umbilical cord IL-6 was the only independent predictor of early-onset neonatal sepsis (odds ratio 13.6, p = 0.004). CONCLUSION: Umbilical cord IL-6 was the only predictor of early-onset neonatal sepsis in PPROM. Contrary to what is reported, funisitis was not.

• MeSH
• Chorioamnionitis metabolism   MeSH
• Adult MeSH
• Enzyme-Linked Immunosorbent Assay MeSH
• Fetal Blood * metabolism   MeSH
• Interleukin-6 * metabolism   MeSH
• Humans MeSH
• Young Adult MeSH
• Infant, Newborn MeSH
• Fetal Membranes, Premature Rupture * metabolism   MeSH
• Prospective Studies MeSH
• Sepsis * metabolism   MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH

OBJECTIVE: To determine the amniotic fluid CD200 levels in uncomplicated pregnancies and in preterm prelabor rupture of the membranes (PPROM) according to microbial invasion of the amniotic cavity and histological chorioamnionitis and its association with neonatal outcomes. METHODS: One hundred and fifty-nine women with singleton pregnancies were included in this study. Amniotic fluid was collected, and CD200 levels were determined using ELISA. ResuLTS: No difference was found in CD200 levels between women in the second trimester and women at term without labor. Women at term with labor had higher CD200 levels than women in the second trimester and women at term without labor. The presence of funisitis in PPROM pregnancies was associated with higher CD200 levels independent of gestational age (with funisitis: median 197.5 pg/mL versus without funisitis: median 61.0 pg/mL; p = 0.003). The need for tracheal intubation and the development of bronchopulmonary dysplasia were associated with higher CD200 levels. CONCLUSIONS: Amniotic fluid CD200 levels remained stable in advanced pregnancy and they were increased during parturition. Elevated CD200 levels in the presence of funisitis suggest the involvement of negative regulatory mechanisms of innate immunity. CD200 may play a role in the development of pulmonary aspects of neonatal morbidity.

• MeSH
• Antigens, CD metabolism   MeSH
• Chorioamnionitis metabolism   MeSH
• Adult MeSH
• Pregnancy Trimester, Second metabolism   MeSH
• Humans MeSH
• Amniotic Fluid metabolism   MeSH
• Labor, Obstetric metabolism   MeSH
• Obstetric Labor, Premature metabolism   MeSH
• Fetal Membranes, Premature Rupture metabolism   MeSH
• Prospective Studies MeSH
• Cross-Sectional Studies MeSH
• Pregnancy MeSH
• Pregnancy Trimester, Third metabolism   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

OBJECTIVE: To determine the amniotic fluid nucleosome concentrations in pregnancies that are complicated by preterm prelabor rupture of membranes and their correlation to microbial invasion of the amniotic cavity (MIAC), histologic chorioamnionitis (HCA), and their association with neonatal outcomes. METHODS: Eighty-nine women with singleton pregnancies were included in this study. Amniotic fluid was collected, and nucleosome concentration in the amniotic fluid was determined using enzyme-linked immunosorbent assay. RESULT: There were no differences observed in the amniotic fluid nucleosome concentrations in women with or without MIAC. The presence of HCA (with chorioamnionitis: median 0.5; without chorioamnionitis: median 0.21; p = 0.01) and funisitis (with funisitis: median 0.85; without funisitis: median 0.22; p = 0.0008) was associated with higher nucleosome concentrations using crude analysis; however, this was not significant after adjusting for gestational age (p = 0.12 for both). A negative correlation was observed between amniotic fluid nucleosome concentrations and gestational age (ρ = -0.52; p < 0.0001). There was no association identified between amniotic fluid nucleosome concentration and neonatal morbidity. CONCLUSIONS: Amniotic fluid nucleosome concentrations remained a stable physiologic constituent in pregnancies complicated by preterm prelabor rupture of membranes, and these concentrations were gestational age dependent. Neither MIAC nor HCA significantly affected amniotic fluid nucleosome concentrations.

• MeSH
• Amniocentesis MeSH
• Amnion microbiology   MeSH
• Bronchopulmonary Dysplasia diagnosis   MeSH
• Chorioamnionitis microbiology   pathology   MeSH
• Adult MeSH
• Enzyme-Linked Immunosorbent Assay MeSH
• Gestational Age MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Nucleosomes chemistry   ultrastructure   MeSH
• Amniotic Fluid chemistry   MeSH
• Fetal Membranes, Premature Rupture metabolism   MeSH
• Respiratory Distress Syndrome, Newborn diagnosis   MeSH
• Pregnancy MeSH
• Pregnancy Outcome * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: PROM and pPROM and early onset neonatal sepsis negatively affect the neonatal perinatal mortality and morbidity. OBJECTIVES: The target of the work was to evaluate the relationship between chorioamnionitis, funisitis and PROM, pPROM and the risk of early onset neonatal sepsis. METHODS: We examined 152 samples of the placenta and umbilical cord, histologically and microbiologically, in 53 women without PROM, 52 women with PROM and 47 women with pPROM. RESULTS: We demonstrated a statistically significant relationship of chorioamnionitis and funisitis to the risk of early-onset neonatal sepsis. We demonstrated no relationship between pathological findings in the placenta and PROM or pPROM. CONCLUSIONS: The histological findings of an amniotic-type placentitis can particularly be used for supporting or possibly excluding the diagnosis of early onset neonatal sepsis.

• MeSH
• Chorioamnionitis pathology   MeSH
• Pregnancy Complications, Infectious pathology   MeSH
• Humans MeSH
• Infant, Newborn, Diseases pathology   MeSH
• Infant, Newborn MeSH
• Perinatal Mortality MeSH
• Placenta pathology   MeSH
• Fetal Membranes, Premature Rupture pathology   MeSH
• Umbilical Cord pathology   MeSH
• Risk Factors MeSH
• Sepsis pathology   MeSH
• Pregnancy MeSH
• Inflammation pathology   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH

OBJECTIVES: to assess the relationship between maternal and umbilical serum concentrations of matrix metalloproteinases (MMP)-2,8,9, the soluble receptor for advanced glycation end products (sRAGE) and IL-10 and premature delivery and fetal inflammation. METHODS: maternal serum levels of MMPs, sRAGE, IL-10 and C-reactive protein (CRP) were determined in 67 women with preterm labor and in 38 healthy pregnant women of similar gestational age (GA). In the group with preterm labor we also determined umbilical concentrations of MMPs, IL-6 and sRAGE. The group with preterm labor was additionally divided based on the presence of funisitis and elevations of fetal umbilical IL-6 concentrations. RESULTS: maternal serum levels of MMP-2 and sRAGE were significantly lower in women with preterm labor compared to women with normal pregnancy. Additionally, within the group of women with preterm labor, maternal serum MMP-2 concentrations were significantly lower in the subgroup with funisitis and in the subgroup with elevated umbilical concentration of IL-6. CONCLUSION: our results demonstrate significantly different serum concentrations of MMP-2 and sRAGE in women with preterm labor compared to healthy pregnant patients of the same GA.

• MeSH
• C-Reactive Protein metabolism   MeSH
• Chorioamnionitis blood   enzymology   MeSH
• Fetal Blood enzymology   MeSH
• Interleukin-10 metabolism   MeSH
• Humans MeSH
• Matrix Metalloproteinases blood   MeSH
• Multivariate Analysis MeSH
• Infant, Newborn MeSH
• Fetus MeSH
• Obstetric Labor, Premature blood   enzymology   MeSH
• Receptors, Immunologic blood   metabolism   MeSH
• Regression Analysis MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Chorioamnionitis MeSH
• Infections MeSH
• Infant, Newborn, Diseases MeSH
• Publication type
• Congress MeSH

OBJECTIVE: To determine changes in the intraamniotic environment during the latency period using paired amniotic and gastric fluid samples in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). METHODS: A total of 34 women with singleton pregnancies complicated by PPROM prior to 34 weeks were included in the study. Amniotic fluid was obtained by transabdominal amniocentesis at the time of admission. Immediately after delivery, umbilical cord blood and gastric fluid were obtained. RESULT: Microorganisms in amniotic and gastric fluid samples were found in 38% and 59% of women, respectively. Bedside IL-6 levels were higher in amniotic than in gastric fluid in pregnancies without fetal inflammatory response syndrome (FIRS) (263 pg/mL vs. 50 pg/mL; p < 0.0001), but not in pregnancies with FIRS (318 pg/mL vs. 444 pg/mL; p = 0.91). Funisitis and FIRS was associated with the highest bedside IL-6 levels in gastric fluid. A gastric fluid bedside IL-6 level of 275 pg/mL was found to be the ideal cutoff value to predict funisitis and FIRS. CONCLUSIONS: The microbial and inflammatory status of the intraamniotic compartment changes during the latency period in PPROM. Bedside IL-6 assessment of gastric fluid may be useful in the rapid diagnosis of funisitis and FIRS.

• MeSH
• Amniocentesis MeSH
• Biomarkers analysis   MeSH
• Chlamydia trachomatis MeSH
• Chorioamnionitis MeSH
• Adult MeSH
• Fetal Blood chemistry   MeSH
• Interleukin-6 analysis   MeSH
• Humans MeSH
• Mycoplasma hominis MeSH
• Infant, Newborn MeSH
• Amniotic Fluid chemistry   microbiology   MeSH
• Fetal Membranes, Premature Rupture * MeSH
• Prospective Studies MeSH
• Syndrome MeSH
• Pregnancy MeSH
• Body Fluids MeSH
• Ureaplasma MeSH
• Gastric Juice chemistry   microbiology   MeSH
• Stomach microbiology   MeSH
• Inflammation MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Cíl studie: Stanovit hladiny solubilního Toll-like receptoru 2 (sTLR2) v pupečníkové krvi novorozenců pacientek s těhotenstvím komplikovaným předčasným odtokem plodové vody (PPROM) za přítomnosti nebo absence histologické chorioamnionitidy (HCA) a funisitidy. Typ studie: Retrospektivní studie. Název a sídlo pracoviště: Univerzita Karlova v Praze, Lékařská fakulta a Fakultní nemocnice v Hradci Králové, Ústav klinické imunologie a alergologie, Porodnická a gynekologická klinika. Metodika: Do studie bylo zařazeno 86 žen s PPROM mezi 24. a 36. týdnem gestačního stáří. Vzorky pupečníkové krve byly odebrány z podvázaného pupečníku ihned po porodu novorozence. Vzorky placenty, plodových obalů a pupečníku byly vyšetřeny na přítomnost zánětlivých změn. Koncentrace sTLR2 v pupečníkové krvi novorozenců byla měřena metodou ELISA. Výsledky: U žen s HCA nebyla zaznamenána rozdílná koncentrace sTLR2 v pupečníkové krvi ve srovnání s ženami bez HCA (s HCA: medián 7,6 ng/mL, interkvartilový rozsah [IQR] 5,1 – 12,3 vs. bez HCA: medián 8,0 ng/mL, IQR 6,0 – 9,4; p = 0,79). Nebyl nalezen rozdíl v koncentraci sTLR2 v pupečníkové krvi mezi skupinami pacientek s funisitidou a bez funisitidy (s funisitidou: medián 7,2 ng/mL,IQR 5,5 – 22,3 vs. bez funisitidy: medián 7,9 ng/mL, IQR 5,2 – 10,5; p = 0,31). Závěr: Hladiny sTLR2 v pupečníkové krvi nejsou ovlivněny přítomností HCA nebo funisitidy u těhotenství komplikovaných PPROM.

Objective: To determine whether umbilical cord blood concentrations of soluble Toll-like receptor (sTLR2) is of value in the diagnosis of histological chorioamnionitis (HCA) and funisitis in pregnancies complicated by preterm premature rupture of membranes. Design: Retrospective study. Setting: Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Department of Clinical Immunology and Allergy, Department of Obstetric and Gynecology. Methods: Eighty six women with PPROM between gestation ages 24 and 36 weeks were included in the study. The samples of the umbilical cord blood were taken from the clamped umbilical cord immediately after delivery of the newborn. The placenta, fetal membranes and umbilical cord were evaluated for the presence of inflammatory changes. The concentrations of sTLR2 in the umbilical cord blood were measured by ELISA method. Results: Women with HCA did not have different umbilical cord blood sTLR2 levels than women without HCA (with HCA: median 7.6 ng/mL, interquartile range [IQR] 5.1 – 12.3 vs. without HCA: median 8.0 ng/mL, IQR 6.0 – 9.4; p = 0.79). No differences between women with and without funisitis were found (median 7.2 ng/mL, IQR 5.5 – 22.3 vs. without funisitis: median 7.9 ng/mL, IQR 5.2 – 10.5; p = 0.31). Conclusion: Umbilical cord blood sTRL2 levels are not affected by the presence of either HCA or funisitis in pregnancies complicated with PPROM.

• MeSH
• Biomarkers MeSH
• Chorioamnionitis MeSH
• Adult MeSH
• Enzyme-Linked Immunosorbent Assay MeSH
• Fetal Blood * immunology   MeSH
• Adrenal Cortex Hormones adverse effects   MeSH
• Pregnancy Complications, Infectious MeSH
• Obstetric Labor Complications MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Fetal Membranes, Premature Rupture * MeSH
• Retrospective Studies MeSH
• Statistics as Topic MeSH
• Pregnancy MeSH
• Toll-Like Receptor 2 * physiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH